Healthcare Provider Details

I. General information

NPI: 1093847477
Provider Name (Legal Business Name): RONALD G. AMAKER & ASSOCIATES, OD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 BLOWING ROCK BLVD STE R
LENOIR NC
28645-3757
US

IV. Provider business mailing address

845 BLOWING ROCK BLVD STE R P.O. BOX 1864
LENOIR NC
28645-3757
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-2816
  • Fax: 828-757-2864
Mailing address:
  • Phone: 828-757-2816
  • Fax: 828-757-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1284
License Number StateNC

VIII. Authorized Official

Name: RONALD AMAKER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 828-757-2816